Current opinion in pediatrics
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To summarize our current understanding of the pathophysiology, diagnosis, and management of acute traumatic coagulopathy in children. ⋯ Prospective studies are needed to determine how to best diagnose and manage acute traumatic coagulopathy in children.
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Curr. Opin. Pediatr. · Jun 2014
ReviewNuking the radiation: minimizing radiation exposure in the evaluation of pediatric blunt trauma.
Our objective is to highlight recent literature investigating low-radiation diagnostic strategies in the evaluation of pediatric trauma. ⋯ More research is needed in development of pediatric-specific clinical decision rules and risk stratification and in testing low-radiation diagnostic modalities in the pediatric trauma population.
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Curr. Opin. Pediatr. · Jun 2014
ReviewA paradigm shift in the treatment of extreme prematurity: the artificial placenta.
Extremely low gestational age newborns (ELGANs), born at less than 28 weeks' estimated gestational age, suffer the greatest consequences of prematurity. There have been significant advances in their care over the last several decades, but the prospects for major advances within traditional treatment modalities appear limited. An artificial placenta using extracorporeal life support (ECLS) has been investigated in the laboratory as a new advance in the treatment of ELGANs. We review the concept of an artificial placenta, the purported benefits, and the most recent research efforts in this area. ⋯ ELGANs suffer the greatest morbidity and mortality of prematurity, and are poised to benefit from a paradigm shift in the treatment. Although challenges remain, the artificial placenta is feasible. An artificial placenta would not only protect ELGANs from the complications of mechanical ventilation, but also support their development until a stage of greater maturity, preparing them for a life free of the sequelae of prematurity.
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To review the current literature on venous thromboembolism (VTE) in critically ill children. ⋯ Pediatric critical care practitioners should be cognizant of the importance of VTE in critically ill children to allow early identification and treatment. Adequately powered clinical trials are critically needed to generate evidence that will guide the treatment and prevention of thromboembolism in critically ill children. Risk assessment tools that incorporate biomarkers may improve our ability to predict the occurrence of thromboembolism in critically ill children.
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Curr. Opin. Pediatr. · Jun 2014
ReviewUse of procalcitonin for the prediction and treatment of acute bacterial infection in children.
Procalcitonin (PCT) is increasingly utilized to determine the presence of infection or to guide antibiotic therapy. This review will highlight the diagnostic and prognostic utility of serum PCT in children. ⋯ PCT is a reliable serum marker for determining the presence or absence of invasive bacterial infection and response to antibiotic therapy. Tailoring antibiotics to PCT levels may reduce the duration of therapy without increasing treatment failure, but more research is needed in children.